ROME 2015 Application

Thank you for applying for this year's ROME. You are eligible for this program if you are a US citizen or permanent
resident who is a high school senior from historically underrepresented racial and ethnic backgrounds (African American,
Latino, Asian American, Native American, Native Hawaiian or Pacific Islander) who is living within the US or US
territories. Preference will be given to students who have yet to visit Reed. Before you fill in the form, take some
time to formulate your essay and short answer responses, as you will not be able to save this form. Please only click
the submit button once. We look forward to reading your application!

* Required field

Applicant Information

First Name*

Middle Name

Last/Family Name*

Preferred Name

Birthdate*

Gender*

Male
Female
Other:

E-mail address*

Cell Phone*

e.g (111) 222-3344

Home Phone

e.g (111) 222-3344

Mailing Address Line 1*

Mailing Address Line 2

City*

State/Territory*

Zipcode*

Do you intend to apply Early Decision to any institution?*

Yes
No

If yes, please specify institution

Demographic Information

Citizenship*

If dual citizen or permanent resident, please elaborate

Place of Birth*
City/Town, State/Province, Country

Ethnic background
Please check all that apply

Asian American
Black or African American
Caucasian
Latino/Hispanic
Native American
Native Hawaiian or Pacific Islander
Other:

Please describe your background and/or tribal affiliation

Primary language spoken at home

Family Information

Parents' Marital Status*

With whom do you make your permanent home?*

Parent 1*

Is Parent 1 living?*

Parent 1 Name*

Parent 1 Country of Birth*

Parent 1 Cell Phone

e.g. (111) 222-3344

Parent 1 Occupation and Name of Employer*e.g. History Teacher, Portland Public Schools

School Information

If you are selected for ROME, this will help us plan which classes you might visit

Academic Interests 1*

Academic Interests 2

Academic Interests 3

List all other secondary schools, including summer schools as well as summer and other programs, you have attended, beginning with 9th grade
Include school name, location (city, state, country) and dates attended. Example: Franklin High School - Portland, OR - 08/2006 to 06/2008

Senior year courses*

Please indicate the courses you are taking for each semester of your senior year.

Fall semester

Spring semester

Test Scores

Please enter your scores for at least one of the following: PSAT, ACT or SAT. If you have AP or IB scores, please enter those in the appropriate space.

I have taken a standardized test (PSAT, ACT or SAT)*
If you have not taken a standardized test at this time, we will not be able to consider your application for ROME.

Extracurricular Information

Please list any academic distinctions or honors you have received during your high school years.
Please indicate at which grade level, and at what level of recognition (school, state, regional, national or international) these honors were achieved. Example: 10 - St. Paul's Book Award - State.

Please list your involvement and the positions held in your primary extracurricular, community, volunteer and family activities, and hobbies during your high school years.
Please indicate at which grade level(s) you participated, and your period of participation (school year, summer, or both). Example: 10-12 - Treasurer - Student Senate - school year

Please list paid jobs, internships, or research positions you have held during the past three years (including summer employment)
Please indicate your position, employer and dates of employment, if applicable. Example: Cashier - Oaks Amusement Park - 06/2009 to 08/2009

Reed Overnight Multicultural Experience Essay *

Please write an essay telling us why you want to attend the Reed Overnight Multicultural Experience, in 250 words or more.

Creative Essay *

According to Howard Thurman, “Don’t ask what the world needs. Ask what makes you come alive, and go do it. Because what the world needs is people who have come alive.” Reed is a place where students come alive. What makes you come alive? (250 words or more)

Final Information

Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, which resulted in your probation, suspension, removal, dismissal, or expulsion from the institution?*

Yes
No

Have you ever been convicted of a misdemeanor, felony, or other crime?*

Yes
No

If you answered yes to either or both questions, please give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience

Additional Information
If there is any additional information you'd like to provide regarding special circumstances, additional qualifications, etc., please do so

Have you sent Reed your high school transcript?*
Remember, your application won't be considered complete until you do. Please e-mail it to applyrome@reed.edu or have it sent to: ROME - Reed College Admission Office, 3203 SE Woodstock Blvd, Portland OR 97202

Yes, I have!
Not yet

Signature

I certify that all information submitted in this application is my own work, factually true, and honestly presented.

I acknowledge that I have reviewed the application instructions for this application.

I understand that I may be subject to a range of possible disciplinary actions, including revocation of the invitation, should the information I've certified be false.

I accept financial responsibility for any and all travel costs incurred by Reed College should I decide not to attend after the travel arrangements have been made.